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There has been a marked increase in spine surgery in the 21st century, but there are no reports providing quantitative and qualitative analyses of research by Korean spine surgeons. The study goal was to assess the status of Korean spinal surgery and research. The number of spine surgeries was obtained from the Korean National Health Insurance Service. Research articles published by Korean spine surgeons were reviewed by using the Medline/PubMed online database. The number of spine surgeries in Korea increased markedly from 92,390 in 2004 to 164,291 in 2013. During the 2000–2014 period, 1982 articles were published by Korean spine surgeons. The annual number of articles increased from 20 articles in 2000 to 293 articles in 2014. There was a positive correlation between the annual spine surgery and article numbers ( p < 0.001). There were 1176 original studies published, and there was an annual increase in articles with Oxford levels of evidence 1, 2, and 3. The mean five-year impact factor (IF) for article quality was 1.79. There was no positive correlation between the annual IF and article numbers. Most articles (65.9%) were authored by neurosurgical spine surgeons. But spinal deformity-related topics were dominant among articles authored by orthopedics. The results show a clear quantitative increase in Korean spinal surgery and research over the last 15 years. The lack of a correlation between annual IF and published article numbers indicate that Korean spine surgeons should endeavor to increase research value. [ABSTRACT FROM AUTHOR]

Surgical treatment is indicated in patients with moderate to severe myelopathy from cervical ossification of the posterior longitudinal ligaments (OPLL), but undertaking prophylactic surgery for asymptomatic or mildly symptomatic patients with a severely compressed spinal cord is debatable. Patients with <8 mm space available in the spinal canal on CT scan, were divided into groups I (mild symptoms, Japanese Orthopedic Association (JOA) score range 15–16) and II (moderate to severe symptoms, JOA score <14). Medical charts including operative records were reviewed to obtain preoperative, perioperative, and final postoperative follow-up data. Group I included 24 patients (20 men, mean age 52.42 years), and Group II included 46 patients (33 men, mean age 54.67 years). Compared to Group II, Group I had a shorter preoperative symptom duration (19.21 vs . 38.23 months, p = 0.046) and a more favorable JOA score at final follow-up ( p = 0.007). The mean numbers of OPLL-involved segments were similar (Group I 2.96, Group II 3.09; p = 0.773) as were the mean numbers of operated segments (Group I 2.71, Group II 3.35; p = 0.076). Perioperative blood loss, operation duration, and hospital stay duration were significantly more favorable in Group I than in Group II. The numbers of surgery-related complications in the two groups were similar. Early surgical treatment for a favorable neurologic recovery with a low perioperative risk can be recommended in patients with severely compressed spinal cord from cervical OPLL who present with mild arm numbness. Surgery-related complications, however, should be carefully monitored regardless of symptom severity. [ABSTRACT FROM AUTHOR]

Abstract: Although the widespread use of MRI has facilitated the diagnosis of subclinical syringomyelia, little information has been established regarding its natural course. To elucidate the clinical course and treatment strategy of incidental syringomyelia without predisposing pathologies, we retrospectively reviewed the clinical course of 12 adult patients with incidental syringomyelia. No patients had any predisposing pathology, including Chiari malformation or spinal cord tumor. Using the medical records and MRI, we analyzed the neurological and radiological features of each patient. After a mean of 39.9months follow-up, no patient developed neurological deterioration. Although one patient had radiological progression without neurological deterioration, 11 patients (91.7%) had no change on MRI. Additionally, all patients experienced a favorable clinical course without surgery. These results indicate that, for patients with incidental syringomyelia without predisposing pathology, close observation rather than surgery can be recommended. [Copyright &y& Elsevier]

Abstract: Background: Complications associated with rigid posterior instrumented fusions of the lumbar spine include pseudarthrosis, accelerated adjacent-segment disease, hardware failure, and iatrogenic fixed sagittal imbalance. Posterior pedicle screw/rod-based dynamic stabilization systems, in which semirigid rods or cords are used to restrict or control, rather than completely eliminate spinal segmental motion, aim to reduce or eliminate these fusion-associated drawbacks. In this study, we analyzed the early radiographic and clinical outcomes of patients treated with the NFix II System (N Spine, Inc., San Diego, California), a novel pedicle screw/rod-based system used as a nonfusion posterior dynamic stabilization system, and compared our results to those of similar systems currently in use. Methods: Seven sites participated in a retrospective assessment of 40 consecutive patients who underwent dynamic stabilization of the lumbar spine with the NFix II System at a single level. (One patient underwent 2 single-level dynamic constructs at noncontiguous levels (L3-4 and L5-S1).) Patients were included based on the presence of spinal stenosis, degenerative spondylolisthesis, adjacent segment degeneration, recurrent disc herniation, symptomatic degenerative disc disease, and degenerative scoliosis requiring dynamic stabilization at 1 level with or without instrumented rigid fusion at a contiguous level. Participants were evaluated preoperatively, with planned postoperative assessments at 3 and 6 weeks (1 center assessed patients at 4 weeks), 3 months, 6 months, and 12 months. The primary clinical outcome measures at each assessment were visual analogue scale (VAS) scores to measure back pain, and Oswestry Disability Index (ODI)1 scores to measure function. Radiographic outcome measurements included evidence of instrumentation failure and range of motion (ROM) based on postoperative flexion-extension radiographs at 3, 6, and 12 months. Results: Forty patients (15males, 25 females) with a mean age of 55 years (range 21–81) were included. Average follow-up was 8.1 months (range 6–12). The mean VAS score improved from 7.6 preoperatively to 3.3 postoperatively (P <.001), and the ODI score from 47.3 to 22.8 (P <.001). Eighty percent of patients were severely disabled or worse (ODI ≥ 41) preoperatively, which was reduced to 13% postoperatively. Of the 10 patients with more than 6 months’ follow-up, only 4 demonstrated adequate flexion/extension effort. ROM measurements in those 4 patients showed that on average 53% of preoperative segmental motion was retained at the dynamically stabilized level 6 months postoperatively. There were no instrumentation-related complications. Conclusions: Results of this limited study indicate that the NFix II System when used as a nonfusion device for dynamic stabilization produces significant improvements in pain and function at short-term follow-up with outcomes comparable to other dynamic stabilization systems. The use of this system was not associated with an increased risk of instrumentation failure. The small number of patients with postoperative severe disability or worse compares favorably to long-term published data on posterolateral fusion. Lastly, in this small sample, ROM was preserved at 6-month follow-up. Clinical Relevance: Posterior pedicle screw/rod dynamic stabilization using the NFix II System seems very effective in improving pain and function scores, at least in the short term (mean postoperative ODI of 22.8). Preservation of ROM is also possible. Longerterm follow-up is necessary to assess sustained clinical improvement, hardware complications, and maintenance in segmental ROM. The NFix II System may be considered an effective alternative to existing dynamic stabilization systems. This device is cleared by the US Food and Drug Administration for use as an adjunct to fusion and has the European CE Marking for use in both fusion and nonfusion applications. [Copyright &y& Elsevier]